# A 55-year-old patient has been diagnosed with ocular melanoma in the right eye. The oncologist has recommended enucleation as the treatment of choice. Which nursing intervention is most appropriate when preparing this patient for surgery? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=541585 > language: ko > subject: Adult Health ## 문제 A 55-year-old patient has been diagnosed with ocular melanoma in the right eye. The oncologist has recommended enucleation as the treatment of choice. Which nursing intervention is most appropriate when preparing this patient for surgery? ## 보기 1. Instruct the patient to avoid all eye movements for 24 hours before surgery 2. Provide emotional support and discuss postoperative prosthetic eye options **✔ 정답** 3. Apply bilateral eye patches to prevent light exposure 4. Administer prophylactic antibiotics to both eyes **정답: 2** ## 해설 Enucleation causes permanent vision loss and body image changes, making emotional support and education about prosthetic options the priority. Other interventions are either incorrect or less critical preoperatively. ## 심화 해설 Understanding the Clinical Scenario The patient is facing enucleation, the surgical removal of the eye, for ocular melanoma. This procedure is a life-altering event that carries profound physical and psychological implications. While the surgery addresses a life-threatening malignancy, it results in permanent vision loss and a significant change in facial appearance. The immediate preoperative period is a critical time for addressing the patient's emotional shock, grief, and anxiety about the future. Analysis of the Correct Answer (Option 2) The most appropriate intervention is to provide emotional support and discuss postoperative prosthetic eye options. This approach is holistic and directly addresses the patient's psychosocial needs, which are paramount at this stage. Research underscores that health-related quality of life (HRQoL) is a central concern for these patients. A prospective cohort study by Sarubbi et al. [1] specifically tracked HRQoL evolution after eye amputation surgery, identifying factors that influence it. The study's very design—measuring outcomes at 3 and 12 months postoperatively—highlights that recovery is a long-term process beginning before surgery. By discussing prosthetic options, the nurse provides a tangible hope for cosmetic rehabilitation, which is a key component of restoring body image and social confidence. A separate study by Meer et al. [2] validated a quality of life questionnaire for patients with acquired anophthalmia wearing a prosthesis, demonstrating that successful prosthetic use is directly linked to improved QoL outcomes. Initiating this conversation preoperatively helps the patient envision a future beyond the immediate loss, facilitating coping and informed consent. Why the Other Options Are Incorrect - Option 1: Instruct the patient to avoid all eye movements for 24 hours before surgery. This instruction is physiologically baseless and clinically irrelevant. There is no mechanism by which eye movements would affect the tumor or the surgical procedure. It imposes an unnecessary and stressful restriction without any therapeutic benefit. - Option 3: Apply bilateral eye patches to prevent light exposure. This intervention is not indicated. The unaffected eye is healthy and should not be occluded, as this would unnecessarily induce sensory deprivation and increase the patient's anxiety and disorientation. The surgical eye does not require patching for light protection preoperatively. - Option 4: Administer prophylactic antibiotics to both eyes. This action is not standard of care. Prophylactic antibiotics, if indicated, are administered systemically or locally to the surgical eye in the immediate perioperative period to prevent surgical site infection, not preoperatively to both eyes. This intervention is not supported by the provided evidence, which focuses on long-term QoL and orbital development, not infection prophylaxis. A study on unilateral enucleation for retinoblastoma focuses on orbital development over a 7.7-year follow-up, with no mention of bilateral prophylactic antibiotics. Pathophysiology and Clinical Reasoning The diagnosis of ocular melanoma triggers a crisis that encompasses fear of cancer, impending blindness, and facial disfigurement. The nurse's role is to mitigate this psychological trauma. The evidence clearly establishes that the patient's postoperative quality of life is a measurable and significant outcome. Sarubbi et al. [1] utilized standardized HRQoL questionnaires to quantify this, while Meer et al. [2] specifically linked the use of an ocular prosthesis to QoL. Therefore, preoperative nursing care must pivot from a purely procedural focus to a psychosocial one. Discussing the orbital implant and subsequent prosthetic fitting provides a crucial bridge from the current state of disease to a future state of cosmetic and social rehabilitation. This conversation directly addresses the factors that the literature identifies as influential on long-term HRQoL, making it the most evidence-based and patient-centered intervention.References (research sources) - [1]Cohort study of global, psychological, and visual quality of life one year after evisceration/enucleation surgery: QOLAE 1 study.Research articleSarubbi C, Yaïci R, Belafkih K, Monin A, Simonin M, Gauthier AS, Solecki L. (2025) · DOI: 10.4103/ijo.ijo_544_25 - [2]Quality of Life in Patients With Acquired Anophthalmia Using an Ocular Prosthesis.Research articleMeer E, Miller AC, Ahmad M, Arnold BF, Kersten RC, Grob SR, Winn BJ, Afshar AR, Vagefi MR. (2025) · DOI: 10.1097/iop.0000000000002722 ## 임상 시나리오 Preparing for Enucleation: Psychosocial PriorityAddressing body image and emotional shock before eye removal The immediate preoperative phase for enucleation must prioritize emotional support. The patient is facing permanent vision loss and a significant change in facial appearance, triggering grief and anxiety about body image. Discussing postoperative prosthetic eye options is a key intervention. It provides tangible hope for cosmetic rehabilitation and restores social confidence. Recovery is a long-term process, and quality of life assessments begin before surgery. CautionAvoid non-therapeutic responses like false reassurance. Do not patch the unaffected eye. The focus is on validating the patient's loss and initiating coping strategies, not just physical preparation. ## 핵심 개념 - **Enucleation** — Surgical removal of the eye, typically leaving the orbital muscles and eyelids intact, often performed for intraocular malignancies like melanoma. - **Ocular Melanoma** — A rare malignant tumor arising from melanocytes within the uveal tract of the eye, threatening vision and requiring aggressive treatment to prevent metastasis. - **Body Image Disturbance** — A subjective alteration in a person's perception of their physical self, commonly triggered by disfiguring surgeries such as enucleation. - **Prosthetic Eye** — An artificial eye shell fitted over an orbital implant after enucleation to restore a natural cosmetic appearance. ## 같은 주제 문제 - [A nurse is assessing a 55-year-old client who has been diagnosed with ocular melanoma. 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